Fig. 3. Cholangiogram showing the use of magnetic compression anastomosis to treat a biliobiliary stricture that developed after living-donor liver transplantation. (A) Endoscopy could not be used to pass a guidewire because of a severe stricture at the site of the anastomosis. After injection of contrast medium through a percutaneous transhepatic tract, the medium did not drain to the common bile duct (CBD) because the obstruction was complete. (B) After insertion of a percutaneous transhepatic biliary drainage (PTBD) catheter, the tract was dilated to 18 F, and a covered self-expandable metal stent was inserted into the CBD. (C) A magnet attached to a polypectomy snare was delivered via an endoscopic retrograde cholangiopancreatography (ERCP) scope through the CBD. (D) A second magnet was fixed to alligator forceps and moved toward the anastomosis site through the PTBD tract. The magnets were approximated, and the PTBD catheter inserted. (E) After removal of the approximated magnets, a retrievable, fully covered, self-expandable metal stent (FCSEMS) was inserted for six months. (F) The FCSEMS was removed, and a new fistula had formed.
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